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The home for VPR's coverage of health and health industry issues affecting the state of Vermont.

Hospital Leader Says NH Lags Vt. In Health Care Changes

The leader of the region’s largest hospital system said Vermont is well ahead of New Hampshire when it comes to creating a sustainable health care system, and that patients in the Granite State may be at a disadvantage when a key provision of the federal health care reform law goes live next month.

Vermont has done much more to plan for the Oct. 1 launch of the online insurance marketplaces known as health exchanges, Jim Weinstein, president and CEO of Dartmouth-Hitchcock, said in a meeting Wednesday with the Valley News editorial board.

Public education efforts in the Green Mountain State also have exceeded those in New Hampshire, he said, and officials in Montpelier are thinking years ahead about how to control costs in the system and reform payment models.

Dartmouth-Hitchcock will keep preparing to treat a potential influx of patients from both states as the federal reforms roll out, Weinstein said, but he warned that the disparities in reform efforts between the Twin States could make life frustrating for Granite State patients and their health care providers.

“I think it’s still pretty complicated in New Hampshire on what’s going to happen. I think Vermont’s doing a better job with the communications and trying to help the public understand how to engage in that process,” Weinstein said. “I think there’s been a lot more money and time. Obviously, (Vermont) has taken federal dollars and New Hampshire hasn’t. The worlds we live in, unfortunately, are quite different.”

As a key provision of the 2010 Affordable Care Act, the health exchanges are supposed to function as online health insurance shopping malls, akin to retail websites such as Amazon. Each state will have its own. Some states have taken the lead in designing their own marketplaces, while other states, including New Hampshire, have deferred to the federal government.

Vermont is using its exchange as a springboard to implement by 2017 a single-payer system, in which the state government, rather than private insurers, would pay health care providers. Vermont is among 16 states plus the District of Columbia that have chosen to run their own exchanges. New Hampshire lawmakers, on the other hand, passed a law in the previous Republican-dominated biennium forbidding a state-run exchange, and Granite State GOPers opposed to “Obamacare” have blocked efforts to draw down federal funds for planning and public education.

Meanwhile, Vermont also has been quicker to take advantage of federal dollars available to expand the state’s Medicaid program, as provided for in the Affordable Care Act. New Hampshire is still contemplating an expansion of Medicaid. A commission headed by former Mary Hitchcock Memorial Hospital president Jim Varnum began studying the issue in July and expects to make a recommendation by mid-October.

Amid this bifurcated environment, Weinstein has been meeting with state and hospital officials on both sides of the Connecticut River to devise ways to eliminate redundancy in the system and coordinate care. Weinstein said he met with Vermont Gov. Peter Shumlin this week and plans to talk with his counterpart in New Hampshire, Gov. Maggie Hassan, later this month.

“I still believe that coordination and consolidation of resources around a population-based strategy versus a market strategy is the way to go. ... I’d like New Hampshire and Vermont to be examples of that,” Weinstein said. “I think both governors seem to be very supportive — but very different states, very different environments.

“Our job ..., no matter what the environment, is to take care of people.”

Weinstein has encouraged political leaders and health officials to go beyond tinkering with specific programs or changing the payment model. What matters most is offering low-cost, high quality care, he said, regardless of who is paying for it.

Dartmouth-Hitchcock has sought partnerships with other Twin State hospitals to share expertise and resources. In so doing, Weinstein also has sought the backing of each state’s political leadership. He said he’s been encouraged by the response, but added that New Hampshire needs to develop goals for improving its health care system and a plan to achieve them.

“We tend to take a few dollars, fix something for a while with no long-term strategy,” he said of the Granite State. “So I would ask the question, what is the long-term strategy for New Hampshire in health care? Vermont seems to have a strategy, whether it’s single payer or not, the governor has been very clear. He was elected on that platform and I think he’s trying to make it happen. ...What’s the long term strategy for New Hampshire? I don’t know. I think it’s a fair question.”

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